Informatics – Is There Really an Impact?

Welcome to my second post, and thank you for the comments!

In my last post, I touched on some of the job responsibilities of the clinical informaticist. Now I’d like to explore the impact of these demanding professions…

Today, we are currently facing a severe industry shortage in several clinical disciplines. A 2010 Survey on Industry Staffing Needs identified areas where healthcare organizations lack qualified candidates. Not surprisingly,

Nearly one-third of those surveyed (healthcare provider organizations) anticipate shortages in clinical informatics positions.
Another quarter anticipated shortages in implementation experts.

If we are experiencing mass shortages, why should we prioritize filling clinical informatics positions?

A CIO in the HIMSS Impact of the Informatics Nurse Survey stated that informatics nurses “[are] absolutely essential; they bring a working knowledge of how a clinical process works or should work and how the information system can or can’t work with that process. Also, they are more likely to recognize risks to failure in the process of recommending process changes or mitigation steps.”

In a broader context, the knowledge of “workflow configuration” and “recognition of failures in the process” can be extended beyond nurses to all clinical informatics disciplines.

This survey also suggests the role of informatics is not limited to information technology! Informatics professionals with a clinical background play a critical role in patient safety, change management and usability of systems as identified by their impact on quality outcomes, workflow and user acceptance.

In the same survey, the following areas were ranked by organizational leaders (CIO, CNO, CMIO, CMO etc.), describing how informatics professionals have a direct impact within their organization:

Accuracy of Documentation
Alerts / Reminders
Design / Configuration
Patient Safety
Quality Outcomes
Reduction of ‘Never Events’
Screen Flow
User Acceptance
Workflow

I would love to hear your feedback on what other areas are missing!

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2 Responses to Informatics – Is There Really an Impact?

Paul Roemer says:

January 5, 2011 at 2:20 pm

I think there is an impact, but for all but a few the impact of informatics is not positive. It is however, exactly the one for which they planned—albeit not deliberately. I think the evidence supports the reasons for the abject pickle in which providers find themselves comes from the fact that most failures can be traced back to the very beginning of a provider’s efforts to implement EHR.

To compound matters, as these same providers look to implement Accountable Care Organizations (ACOs) to their existing business models, they will find themselves pickling their entire informatics effort.

A hospital CEO recently confided to me that his peers could not be less qualified when it comes to the skills needed to select an EHR system. He stated EHR decisions are being made based on what others have done, on conversations had at a trade show, or on a pitch from a vendor.

Now, before we start slamming the vendors and their products—as I can be fond of doing—I do not think most EHR failures have as much to do with the vendors as they have to do with the providers. Very little documented rigor exists when it comes to selecting an EHR vendor. In fact, I would wager many large providers issued a more detailed request for proposal (RFP) to select their cafeteria vendor than they did for the EHR.

I am a firm believer that if you cannot find something on Google, the reason you cannot find it is that it does not exist. Googling EHR RFP does not offer anything useful. Is that perhaps because there are not many providers who have developed a meaty EHR RFP?

There are a number of providers who are on version 2.0 for the EHR. They are doing so under the mistaken belief that the problems they encountered with version 1.0 had to do with the software. Looking at the large provider EHR landscape, there are providers who are switching from vendor A to vendor B. Now, if that was the only thing going on, one might find cause to blame vendor A. Unfortunately, other providers, some in the same town are switching from vendor B to vendor A which sort of leads one to suspect that perhaps the software is not the problem.

An argument can be made that if a provider selects its EHR from among the leading 5-7 vendors, they should have about an equal chance of having a successful implementation. At some providers, vendor A is working reasonably well. At other providers, vendor B is working reasonably well.

Of course, as the evidence supports, providers have about an equal chance of having an unsuccessful EHR implementation. Some providers are trying to make the argument that after implementing EHR—and spending an excess of one hundred million dollars—having a productivity loss of around twenty percent does not mean their EHR implementation failed.

I think one can state categorically that if your productivity drops twenty percent, your implementation failed. I think that if your EHR plan at the outset predicted a twenty percent productivity drop, your EHR project would never have been approved.

So, why the mess? If a provider ran a disaster recovery project on what went wrong, the most likely answers would come down to many of the items you listed in your post; a lack of requirements, poor planning, and a morbid lack of time and resources directed to process alignment and change management. Why is this the case? I think it is because the target providers are trying to hit has more to do with meeting Meaningful Use than with implementing an EHR that will meet their needs.

Two years from now when providers reassess informatics in light of the failure of ACOs, it will likely come down to these same issues. There is plenty of time to get these issues right. But then again, there is always plenty of time to do it twice.

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